Short wire cable catheter

ABSTRACT

A balloon catheter device ( 1700 ) includes an elongate catheter shaft comprising multifilar cable tubing ( 1706 ) having a proximal portion and a distal portion. The proximal portion includes a coating ( 1708 ) that allows the shaft to provide a patent fluid passage. The distal cable tube end includes a connection structure ( 1723 ) configured to provide desirable strength, pushability, and trackability.

RELATED APPLICATIONS

The present patent document claims the benefit of the filing date of andpriority to Provisional U.S. Patent Application Ser. Nos. 61/247,175,filed Sep. 30, 2009, and 61/367,534, filed Jul. 26, 2010, and to PCTApplication No. PCT/US2010/049758, each of which is incorporated hereinby reference.

TECHNICAL FIELD

The present application relates to medical catheters, and morespecifically to medical balloon catheters useful in endovascular andother body lumens.

BACKGROUND

Medical delivery catheters are well known in the art of minimallyinvasive surgery for introduction of fluids and devices to sites insidea patient's body. For example, balloon dilation of luminal stenoses(e.g., in procedures such as angioplasty or balloon dilation of a bileduct), stent placement, and introduction of radio-opaque contrast fluidsare common uses of catheters.

The most widely used form of angioplasty makes use of a dilationcatheter having an inflatable balloon at its distal end. In coronaryprocedures, a hollow guide catheter or wire guide typically is used forguiding the dilation catheter through the vascular system to a positionnear the stenosis (e.g., to a coronary arterial lumen occluded byplaque). Using fluoroscopy, the physician guides the dilation catheterthe remaining distance through the vascular system until a balloon ispositioned to cross the stenosis. The balloon is then inflated bysupplying pressurized fluid, through an inflation lumen in the catheter,to the balloon. Inflation of the balloon causes a widening of the lumenof the artery to reestablish acceptable blood flow through the artery.In some cases, a stent may be deployed with or instead of the balloon towiden and hold open the occluded arterial lumen.

Preferably a catheter used in endovascular lumens will have severalphysical characteristics. The profile and shaft size of the dilationcatheter should be such that the catheter can reach and cross a verytight stenosis. Portions of the dilation catheter must also besufficiently flexible to pass through a tight curvature or tortuouspassageway, especially in a catheter adapted for use in the coronaryarteries. The ability of a catheter to bend and advance effectivelythrough the endovascular or other lumens is commonly referred to as the“trackability of the catheter.” Another important feature of a dilationcatheter is its “pushability.” Pushability involves the transmission oflongitudinal forces along the catheter from its proximal end to itsdistal end so that a physician can push the catheter through thevascular or other lumenal system and the stenoses. Effective cathetersshould be both trackable and pushable.

Two commonly used types of dilation catheters are referred to as“long-wire” catheters and “short-wire” catheters. A long-wire catheteris one in which a wire guide lumen is provided through the length of thecatheter that is adapted for use with a wire guide that can first beused to establish the path to and through a stenosis to be dilated. Thedilation catheter can then be advanced over the wire guide until theballoon on the catheter is positioned within the stenosis.

In short-wire catheters, the wire guide lumen may not extend the entirelength of the catheter. In this type of catheter, the wire guide lumenmay extend only from the distal end of the balloon to a pointintermediate the distal and proximal ends of the catheter. This shorterlumen is the only portion of the catheter contacting the wire guide. Itis sometimes desirable to exchange this first catheter and/or balloonfor a second catheter (e.g., to “exchange out” a balloon catheter, andthen “exchange in” a stent-deployment catheter). The exchange ispreferably executed by leaving the wire guide in place during removal ofthe first catheter and using it as a guide for the second catheter. Thefirst catheter is withdrawn or otherwise removed over the wire guide,and then a second catheter is introduced over the wire guide.

Short-wire catheters are often easier to exchange than catheters havingthe wire guide lumen extending the entire length of the catheter. Thisis because the wire guide need not be as long as a “long wire”configuration, which requires that a length of the wire guide extendingoutside the patient's body be longer than the portion of the catheterextending over the long wire guide in order for a doctor or assistant tomaintain a grasp on the wire guide (to avoid undesired movement ordisplacement thereof). The short wire guide configuration catheters alsocreate less friction during mounting and exchange operations due to theshorter wire guide lumen, leading to a reduced likelihood of displacingthe wire guide.

Catheters for use in endovascular lumens typically require a variationin physical properties along different portions thereof. For example, acertain degree of stiffness is required for pushability and trackabilitynear the proximal end while distal end requires a great deal offlexibility. A catheter having uniform properties throughout its lengthposes disadvantages in that it is likely to be too proximally flexibleor too distally stiff. As a result, most catheter shafts (especiallyendovascular catheters) are made from multiple materials along the shaftlength. For example, a catheter shaft may have a stiff proximal portionmade of metal hypotube, a middle portion made of a stiff plastic, and adistal portion made of a more flexible plastic. This combination ofmaterials poses problems of cost and efficiency in construction, and thejunctions provide problematic possibilities for structural failure (suchas binding, kinking, or even separation) as well as requiringspecialized connection means. In another example, a catheter shaft maybe made of plastic for a major part of its length, but have a stiffeningwire disposed through a significant portion of that length to enhancestiffness. Some long wire catheters rely almost wholly on placement of awire guide therethrough to retain the needed stiffness, which presentsthe problems of length and unwieldiness discussed above. In contrast,the proximal sections of short wire catheters must have adequatestiffness independent of the wire guide.

BRIEF SUMMARY

In one aspect the present invention provides a catheter device,adaptable for use in endovascular lumens or other body lumens, that hasa construction of multifilar cable tubing for a substantial portion ofits length and that is adaptable for use in a short-wire or long-wireconfiguration. The embodiments described and claimed herein provide amultifilar catheter shaft having good pushability and trackability.Embodiments of the present invention may be adaptable for a variety ofapplications (e.g., placement of expandable stents, balloon dilation ofstenoses) and use in a variety of surgical locations (e.g., vascular,gastroenterological). The embodiments herein may be adaptable for use ina variety of minimally invasive surgical treatments (including, e.g.,angioplasty or bile duct dilation).

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a perspective view of a catheter, with an enlarged detailview of the catheter's distal end;

FIG. 1B is a perspective view of a tapered catheter device, with anenlarged detail view of the catheter's distal end;

FIG. 2 is a perspective view of a catheter shaft with a sleeve;

FIG. 3A is a perspective view of a catheter device having a distalextension and an inflation balloon, with an enlarged detail view of thefeatures at the catheter's distal end;

FIG. 3B is a perspective view of a catheter device with an inflationballoon;

FIG. 4A is a perspective view of a catheter device having an externaldistal wire guide lumen structure, with an enlarged detail view of thefeatures at the catheter's distal end;

FIG. 4B is a perspective view of a catheter device having an externaldistal wire guide lumen structure and an inflation balloon, with anenlarged detail view of the features at the catheter's distal end;

FIG. 4C is a perspective view of a catheter device with a distal duallumen structure having a wire guide lumen structure and a mountingportion;

FIGS. 5A-5B show a side view of catheter devices having a distalextension and a wire guide lumen structure;

FIG. 5C is a side view of a catheter device having an external distalwire guide lumen structure and an inflation balloon;

FIG. 6 is a side view of a tapered catheter device having an externaldistal wire guide lumen structure and an inflation balloon;

FIG. 6A is a detail of FIG. 6 and shows a longitudinal cross-sectionalview of the tapering portion and external wire guide lumen of a catheterdevice;

FIG. 6B is a detail of FIG. 6 and shows a longitudinal cross-sectionalview of the distal portion of the catheter device, with an enlargeddetail view of features where the catheter shaft meets the balloon;

FIG. 6C is a transverse cross-sectional view of a dual-lumen mountingsleeve;

FIG. 6D is a transverse cross-sectional view along line 6D-6D of FIG. 6Bshowing two lumens of the catheter device surrounded by a mountingsleeve;

FIGS. 7A and 7B illustrate a cross-sectional view of another embodimentof a catheter device;

FIG. 8 illustrates a partial cross-sectional view of yet anotherembodiment of a catheter device;

FIGS. 9-9E depict still another catheter device embodiment, including awire guide lumen tube; and

FIGS. 10-10A show yet another catheter device embodiment.

FIG. 11 is a side view of a multifilar catheter device having a distalwire guide lumen structure and an inflation balloon;

FIGS. 11A-11B are detail views of FIG. 11;

FIG. 11C is a longitudinal cross-sectional view of a dual-lumen mountingsleeve;

FIGS. 11D-11G show transverse cross-sectional views of the catheterdevice of FIG. 11;

FIGS. 12A-12K show one method of making a catheter of the presentinvention;

FIGS. 13 and 13A-13C show another catheter embodiment and three sectionviews of that embodiment, along lines A-A, B-B, and C-C, respectively;

FIG. 14 shows one embodiment of a transition between the cable tubeshaft portion and a polymer tube shaft portion of the catheter of FIG.13;

FIG. 15 shows another embodiment of a transition between the cable tubeshaft portion and a polymer tube shaft portion of the catheter of FIG.13;

FIGS. 16A and 16B show, respectively, partially unassembled andassembled proximal and distal catheter portions of a catheterembodiment;

FIGS. 17A and 17B show, respectively, partially unassembled andassembled proximal and distal catheter portions of another catheterembodiment; FIGS. 17C and 17D show, respectively, transverse sectionviews along lines 17C-17C and 17D-17D of FIG. 17B;

FIG. 18 shows a partial-section longitudinal side view of the assembledcatheter embodiment of FIGS. 17A-17B;

FIGS. 18A-C show transverse section views of the catheter embodiment ofFIG. 18;

FIGS. 19A and 19B show, respectively, partially unassembled andassembled proximal and distal catheter portions of a catheter embodimentthat includes an alternative feature for the catheter embodiment ofFIGS. 17A-17B; and

FIGS. 20A and 20B show, respectively, partially unassembled andassembled proximal and distal catheter portions of another catheterembodiment.

DETAILED DESCRIPTION

In one aspect, presently described embodiments of a multifilar tubecatheter shaft may be adaptable for use in a variety of minimallyinvasive surgical applications (e.g. endoscopic procedures, central orperipheral cardiovascular intervention procedures such as, for example,angioplasty).

The embodiments are described with reference to the drawings in whichlike elements are generally referred to by like numerals. Therelationship and functioning of the various elements of the embodimentsmay be understood by reference to the drawings and the followingdetailed description. However, the embodiments described are provided byway of example only, and the invention is not limited to the embodimentsillustrated in the drawings. It should also be understood that thedrawings are not necessarily to scale, and—in certain instances—detailshave been omitted that are not necessary for an understanding of theembodiments such as conventional details of fabrication and assembly.Specifically, with reference to scale, the proportion of wall thicknessto lumen size and other components shown is not drawn to scale in manyof the embodiments illustrated herein. Throughout the specification, theterms “distal” and “distally” shall denote a position, direction, ororientation that is generally away from the physician (including anyother person holding/operating a device) and/or toward a treatmentzone/patient. Accordingly, the terms “proximal” and “proximally” shalldenote a position, direction, or orientation that is generally towardsthe physician.

FIGS. 1A-1B illustrate an embodiment of a catheter device 100 with ashaft 101 constructed of a multifilar material (also known as cabletubing) and having an internal lumen 102. The multifilar tubingdescribed is made of a plurality of wires twisted together and leaving acentral lumen. Such multifilar tubing may be obtained, for example, fromAsahi-Intecc (Newport Beach, Calif.) or from Fort Wayne Metals (Ft.Wayne, Ind.) as Helical Hollow Strand®. Materials and methods ofmanufacturing suitable multifilar tubing are described in Published U.S.Pat. No. 7,117,703 (Kato et al.), the contents of which are incorporatedherein by reference. Use of multifilar tubing in a vascular catheterdevice is described in U.S. Pat. No. 9,589,227 (Sonderskov Klint, etal.; Assigned to Cook Inc. of Bloomington, Ind. and William Cook Europeof Bjaeverskov, Denmark), which is also incorporated herein byreference. As illustrated in the embodiments shown herein, a preferredmultifilar tubing of the present invention may include a monolayer ormultilayer multifilament tubing, which includes at least one columnarlayer of generally parallel filers and is distinguished from cross-woundmultifilar tubing or braided tubing where fibers are interlaced,interwoven or otherwise overlapped as is known and used in the art.Described another way, a preferred multifilar tubing of the presentinvention includes a wire-stranded hollow coil body, which includes aplurality of coil line elements stranded along a predetermined circularline to form a flexible linear tube having a central axial hollowportion forming a lumen. In addition, preferred multifilar tubing of thepresent invention is distinguished from multifilar wire guides as havinga fluid-patent lumen configured for efficient fluid communication (e.g.,of pressurized inflation fluid; the terms “patent,” “fluid-patent,” andderivatives thereof are used herein to describe a lumen or other passagethrough which a fluid may travel with essentially no leakage). Apreferred monolayer multifilar tubing provides desirable pushability andtrackability with low probability of kinking. The monolayer tubing mayinclude interior or exterior coatings. However, it should be noted thatspiral-cut and non-spiral-cut hypotube may also be used within the scopeof the invention in the following embodiments wherever multifilar/cabletube is described (unless hypotube is specifically excluded).Generically, the term “metal alloy tube” may be used to describemultifilar and/or hypotube, but the use of any of these terms hereinshould generally be understood to include or be interchangeable with theothers, unless specifically excluded.

In FIG. 1A, the exterior diameter 107 is approximately the same alongthe length of the shaft 101. In the embodiment shown in FIG. 1B, theproximal end 104 has a greater exterior diameter than the distal end106. The catheter shaft 101 tapers toward a smaller exterior diameter108 at the distal end 106. Tapering can enhance flexibility of the shaft101 in several ways. For example, flexibility is enhanced by decreasingthe outside diameter of the catheter shaft 101. The portion of thecatheter shaft 101 having a smaller diameter is more flexible than theportion having a larger diameter. Such tapering also decreases thethickness of the wall of the catheter shaft 101. Alternatively, taperingmay be used within the internal diameter of a catheter, enhancingflexibility by decreasing wall thickness without altering the exteriordiameter of the shaft 101. The steepness and location of the tapering isdetermined by the desired application for the catheter shaft 101. Forexample, in alternative embodiments, there may be multiple stepwise orgradual differences in diameter to confer different degrees offlexibility throughout the length of the catheter. For example, cathetershaft 101 for use in coronary arteries will typically benefit from asmaller diameter than a catheter shaft 101 for use in a bile duct, bothfor gross size and flexibility. A grinding process or other suitableprocess may be used to reduce the exterior diameter as appropriate forthe desired application. Reducing the exterior diameter provides anadded benefit by reducing the profile of the device. The flexibility ofthe catheter shaft 101 or a portion thereof may also be altered byincreasing or decreasing the number of filers. In one aspect, theembodiments described herein also provide a catheter shaft havingconsistent construction material throughout most of the length of thecatheter shaft, with gradual transition from a stiffer proximal end to amore flexible distal end and lacking sharp transitions that underminestructural integrity.

A further embodiment of the catheter shaft 101 includes a coating oninternal and/or external surfaces for at least a portion of the cathetershaft 101. The coating is selected to confer or improve one or moreproperties of reduced friction, flexibility, and sealing a lumen 102 ofthe catheter. Sealing the lumen 102 allows the lumen to be used, forexample, for introduction of inflation fluid to a dilation balloon orintroduction of a medicative substance or radio-opaque contrast fluid.

The coating may be, for example, a sheath or sleeve 202 as illustratedin FIG. 2. In various alternative embodiments, the sheath 202 maycomprise an extruded sleeve, shrink tube, extruded over-jacket, or dipcoat. The sheath 202 is preferably a thermoset material or athermoplastic material and may comprise, for example, HDPE, PTFE, PET,polyester or polyether block amide (PEBA), polyurethane, polyimide,polyolefin, nylon, or any combination thereof. The coating may beapplied by, for example, over-extrusion, dip-coating, melt fusion, orheat shrinking. For example, PET shrink tube 202 has the advantage ofproviding an increased stiffness to a small diameter catheter shaft 201.On the other hand, a PEBA shrink tube 202 can be used with a largerdiameter catheter shaft 201 where greater flexibility is desired. Thetype of sleeve 202 material may also be selected to complement othercatheter components; for example, a nylon sleeve 202 may bond andinteract better with a nylon expandable member (e.g., balloon or basket)and/or a nylon wire guide lumen. Selection of coating materials, filarsize and number, and diameter allow manipulation of the catheter shaft'sshore hardness to offer the desired functional properties.

FIGS. 3A-3B illustrate embodiments of balloon catheters 300 comprising amultifilar shaft 301. In the embodiment of FIG. 3A, the catheter shaft301 has a distal extension 302, upon which is mounted an inflationballoon 304. The distal extension 302 can be formed of the same group ofmaterials used in the coating (HDPE, PTFE, PEBA, PET, polyurethane,polyimide, polyolefin, nylon, or any combination thereof) and provides ashaft portion that may be more flexible than the shaft 301. As canclearly be seen in the detail illustration portion of FIG. 3A, theextension 302 encloses an inflation lumen 306 which continues from aninflation lumen 306 of the multifilar catheter shaft 301. The extension302 also encloses a wire guide lumen 308. In the illustrated long wireconfiguration catheter 300, the wire guide lumen extends from theproximal end of the multifilar catheter shaft 301 and extends throughthe inflation balloon 304 at the distal end.

The embodiment illustrated in FIG. 3B has an inflation balloon 304disposed directly on the distal end of the catheter shaft 301. Aninflation lumen 306 of the multifilar catheter shaft 301 opens into theinflation balloon 304. A wire guide lumen 308 traverses the interior ofthe balloon 304, continuing the wire guide lumen 308 of the cathetershaft 301 to a point distal of the inflation balloon 304. As illustratedan expandable stent 312 may be positioned about the balloon 304. In analternative embodiment, an expandable member other than a balloon (e.g.,a basket) may be disposed near the distal end of the catheter shaft 301.Such an embodiment optionally may have a wire guide through theexpandable member. At its proximal end the catheter 300 has a port 310in fluid communication with the inflation lumen 306. In an alternativeembodiment, the port 310 offers access to the guide wire lumen 308. Theport 310 may be included in other embodiments, and in other positions onthe catheter 300. In another alternative embodiment, the catheter shaft301 has two ports 310, offering separate access to each of the inflationlumen 306 and the wire guide lumen 308. In other alternativeembodiments, the port 310 may be useful for introducing another fluidsuch as a contrast fluid.

FIGS. 4A-4B illustrate embodiments of a multifilar tube balloon catheterdevice 400 comprising a multifilar shaft 401 and further comprising anexternal, distally disposed short wire guide lumen structure in the formof a cannula 402 having a wire guide lumen 404 disposed therethrough. InFIG. 4A, the cannula 402 is attached on the distal end 408 of themultifilar catheter shaft 401 using an adhesive. Alternative means ofattachment include, for example, forced convection heating, radiofrequency heating, ultrasonic welding, and laser bonding. Alternatively,shrink tubing may be used as a manufacturing aid to help compress andfuse the cannula 402 to the multifilar catheter shaft 401. The shrinktubing may be removed and disposed of after the cannula 402 is connectedto the catheter shaft 401, or may remain on as part of the connectedstructure. If the multifilar catheter shaft 401 has a coating, thecannula 402 may be bonded to the coating or directly to the cathetershaft 401. A heat shrink tubing, for example PEBA, may be applied overthe entire assembly, which increases the strength of the assembly. Inthe embodiment shown in FIG. 4B, the cannula 402 is constructed ofmultifilar tubing. An inflation balloon 406 is mounted on the distal end408 of the catheter shaft 401. An inflation lumen 405 of the cathetershaft 401 is open to the interior of the inflation balloon 406. Thecannula 402 extends through the inflation balloon 406 and has anextension 407 on its distal end. A wire guide lumen 404 runs through thelength of the cannula 402 and its extension 407. Although not shown, itshould be appreciated that an expandable stent can be disposed about theballoon 406. The cannula 402 providing a wire guide lumen structure canbe formed of HDPE, PTFE, PEBA, PET, polyurethane, polyimide, polyolefin,nylon, or any combination thereof. In one embodiment, the cannula 402comprises a PTFE inner liner and a PEBA outer cover. Other materials maybe used as an inner liner such as, for example, HDPE, PET, andpolyimide.

In FIG. 4C, a dual lumen structure 410 is disposed on the distal end 408of the multifilar catheter shaft 401. A portion of the length of duallumen structure 410 has a “figure 8” cross section. A mounting portion412 of the dual lumen structure 410 has a lumen 414. The distal end 408of the catheter shaft 401 fits into the lumen 414. The lumen 414 may becompletely occupied by the distal end 408 of the catheter shaft 401, ormay continue coaxially beyond the distal end 408 so as to form anextension. If the mounting portion 412 is placed as an extension, thelumen 414 is in fluid communication with a lumen 420 of the shaft 401. Awire guide portion 416 of the dual lumen structure 410 has a wire guidelumen 418 running therethrough. The dual lumen structure 410 is attachedon the distal end 408 of the catheter shaft 401 using one of theattachment methods described for the embodiment shown in FIG. 4A. Inthis embodiment, the lumen 414 of the dual lumen structure is in fluidcommunication with a lumen 405 of the catheter shaft 401. In analternative embodiment, a part of the mounting portion 412 is mountedinside the lumen 420 of the catheter shaft 401.

FIGS. 5A-5C illustrate embodiments of a balloon catheter 500incorporating a multifilar shaft 501 and having a short wire guideconfiguration. The embodiments shown in FIGS. 5A-5B each have a coaxialextension 502 of the multifilar shaft 501, a short wire guide lumenstructure in the form of a tube 504, and an inflation balloon 506. Thecoaxial extension 502 may have the same or a different flexibility thanthe multifilar shaft 501. In the embodiment illustrated in FIG. 5A, theproximal end 508 of the tube 504 is disposed distal of the juncture ofthe extension 502 with the multifilar shaft 501. The tube 504 enters theextension 502 and extends through the distal end of the balloon 506.Thus, this embodiment comprises a distal extension of the shaft (in thiscase the coaxial extension 502) and the wire guide lumen structure 504,a portion of the wire guide lumen structure 504 being coaxial within thedistal extension, another portion of the wire guide lumen structure 504being outside the distal extension adjacent thereto.

In the embodiment illustrated in FIG. 5B, the proximal end 508 of thetube 504 is disposed proximal of the juncture of the extension 502 withthe multifilar shaft 501. The tube 504 enters the extension 502 andproceeds through the distal end of the balloon 506. Thus, thisembodiment comprises a distal extension of the shaft (in this case thecoaxial extension 502) and the wire guide lumen structure 504, a portionof the wire guide lumen structure being coaxial within the distalextension, another portion of the wire guide lumen structure 504 beingoutside the shaft adjacent thereto. The embodiment illustrated in FIG.5C does not have an extension. The balloon 506 is disposed on the distalend of the multifilar shaft 501. The proximal end 508 of the tube 504 isdisposed proximal of the juncture of the extension 502 with themultifilar shaft 501 and is affixed to the exterior of the multifilarshaft 501. The tube 504 passes through the middle of the balloon 506 andproceeds through the distal end of the balloon 506. In each of theembodiments shown in FIGS. 5A-5C, the placement of the proximal end 508of the tube 504 along the multifilar shaft 501 affects the flexibilityof the shaft 501. Therefore, variation in the placement is useful inincreasing or reducing flexibility as desired in other embodiments.

FIG. 6 illustrates one embodiment of a balloon catheter 600 having anelongate shaft 601 comprising a multifilar tube. An inflation balloon602 is disposed near the distal end. FIG. 6A is an enlarged detailillustration of a middle section of the catheter 600. As can be clearlyseen in FIG. 6A, the shaft 601 includes an external wire guide lumen 604and an internal inflation lumen 606. As shown in FIG. 6A, thisembodiment the catheter shaft 601 is coated with a PEBA coating 603. Thecoating 603 serves to reduce friction during introduction of thecatheter shaft 601 and provides a seal to prevent leakage of inflationfluid from the inflation lumen 606 through the walls of the shaft 601.As can also be seen in FIG. 6A, the catheter shaft 601 tapers distallyto a smaller diameter along the region 605.

FIG. 6B is an enlarged detail illustration of a distal section of theballoon catheter 600. As shown in FIG. 6B, the inflation lumen 606 opensinto the inflation balloon 602, and the wire guide lumen 604 extendsthrough the balloon 602 to the distal end 607. FIG. 6B includes anenlarged detail portion more clearly illustrating the relationshipbetween the balloon 602 and the two lumens (604 and 606). In thisembodiment, the balloon 602 and wire guide lumen 604 are mounted to theshaft 601 with a PEBA shrink sleeve 608. As shown in FIG. 6C, across-sectional view of the sleeve 608 has approximately a figure-eightshape before mounting. The sleeve 608 has two central apertures (610 and612) to allow mounting the sleeve 608 over the wire guide lumen 604 andthe shaft. In this embodiment, after the balloon 602 and wire guide 604are assembled to the shaft 601 together with the sleeve 608, the sleeve608 is heated to shrink and form to the assembly of shaft 601, balloon602, and wire guide 604. FIG. 6D is a transverse cross section alongline 6D-6D of FIG. 6B, and shows the finished configuration. The sleeve608 forms to the shaft 601 and leaves open the inflation lumen 606 andthe wire guide lumen 604.

Cross-lumen communication may be prevented. For example, the walls ofthe multifilar tube of the elongate shaft 601 may be porous, andpressure exerted on an inflation fluid in the inflation lumen 606 mayurge inflation fluid into the wire guide lumen 604. According to oneaspect, this may be prevented by lining the wire guide lumen 604 with aliner such as, for example, PTFE, although other materials may be used.Furthermore, an inner coating segment may be placed over the elongateshaft 601 beneath the proximal breach or side opening of the wire guidelumen 604. The inner coating segment may be, for example, PEBA. Theinner coating segment may be implemented to alter flexibility in thearea of the segment, for example to avoid abrupt changes in flexibility.In one embodiment, the proximal end of the segment terminates at abouthalfway through the taper and the distal end of the segment terminatesjust distal of the proximal breach or side opening of the wire guidelumen 604. According to another aspect, cross-lumen communication may beprevented by placing the coating 603 over essentially the entire lengthof the elongate shaft 601, and the sleeve 608 may subsequently be placedover the coating 603 and elongate shaft 601. According to yet anotheraspect, cross-lumen communication may be prevented by simply making thewalls of the sleeve 608 thicker. A 0.001 inch (0.025 mm) wall thicknessof the coating 603 or sleeve 608, for example, may be sufficient. Asmentioned previously, the coating 603 and sleeve 608 may be PEBA oranother suitable material. These principles may be implemented in otherembodiments of the invention as may be desirable due to fluid beingpassed through or injected into one of the lumens.

FIGS. 7A-7B illustrate a cross-sectional view of a portion of a catheterdevice 700 according to one aspect of the present invention. A shaftwall comprising multiple filers 702 includes an inner coating 701 and anouter coating 703, and surrounds a first lumen 704 and a second lumen706. A wire guide 708 extends through the first lumen 702, and astent-deployment shaft 710 extends through the second lumen 706. Asshown in FIG. 7A, the catheter device 700 includes a distal extension712 that houses a self-expandable stent 714. FIG. 7B illustrates thestent 714 having been pushed out of the second lumen 706 by thestent-deployment shaft 710 such that the stent 714 is deployed. Prior todeployment of the stent 714, the wire guide 708 is typically retractedinto the shaft wall or lumen 704 so as not to interfere with deploymentof the stent 714.

FIG. 8 illustrates a partial cross-sectional view of another embodimentof a catheter device 800, including a self-expanding stent 810. Thecatheter device 800 has a central lumen 802 surrounded by a first, outertubular multifilar body 804. A second, inner multifilar cable tube iscoaxially disposed in the central lumen 802 for use as a pusher 806. Thepusher 806 has a protruding engagement surface 808 for pushing theself-expanding stent 810 out of the central lumen 802 or for holding thestent 810 as the outer tubular multifilar body 804 is being pulled in aproximal direction. A tapered tip 12 is mounted on the distal end of thepusher 806, and provides a minimally traumatic leading surface for thecatheter device 800. A wire guide 814 extends through a central wireguide lumen 816 of the pusher 806. Optionally, apertures (not shown) maybe provided through the side of the outer tubular body 804 and thepusher 806 to permit the wire guide 814 to exit the central lumen 802and the wire guide lumen 816 at an intermediate location. Theself-expanding stent 810 is adapted to be deployed when a user retractsthe outer tubular body 804 proximally while holding the pusher 806substantially in place. The protruding engagement surface 808 of thepusher 806 holds the self-expanding stent 810 substantially in placewhile the outer tubular body 804 is withdrawn from around it. Once thestent 810 is deployed, the pusher 806 and wire guide 814 are withdrawn,leaving the stent 810 in the position where it was deployed.

FIGS. 9-9E illustrate one embodiment of a balloon catheter device 900having an elongate multifilar tube shaft 901 and being configured foruse in a short-wire application using a wire guide. An inflation balloon902 is disposed near the distal end of the device 900 and is sealedthereto. FIG. 9A is an enlarged detail illustration of an intermediatesection of the catheter 900. As shown in FIGS. 9 and 9A, the catheter900 includes an internal shaft lumen 906 and an external wire guidelumen 904 a that is housed by a wire guide tube 904. As shown in FIG.9A, the shaft 901 may be coated with a PEBA or other coating 903. In oneaspect, the coating 903 may help to reduce friction during introductionof the catheter shaft 901 and provide a seal that prevents leakage ofinflation fluid from the shaft lumen 906 through the multifilar wall ofthe shaft 901. Those of skill in the art will appreciate that a coating903 may be disposed on the exterior of the shaft 901, or it may bedisposed as a lining/coating on the interior/lumenal surface of theshaft lumen 906, or both. As is also depicted in FIG. 9A, the cathetershaft 901 tapers distally to a smaller diameter along a narrowingtransitional region 905, which provides for a distal shaft portion thatis more flexible than the proximal shaft portion. An increased distalflexibility may allow the catheter device 900 to be more readilynavigated through tortuous passages.

FIG. 9B is an enlarged detail illustration of a distal section of theballoon catheter 900. As shown in FIG. 9B, both the shaft 901 and thewire guide lumen tube 904 extend through the balloon 902 to the distalend 907. The distal end of the shaft 901 may be provided with a sealingtip 909, which preferably has an atraumatic distal profile. FIG. 9Cshows an enlarged detail portion of FIG. 9B to illustrate therelationship between the balloon 902 and the wire guide and shaft lumens(904 a and 906). The portion of the shaft 901 inside the balloon 902does not include the coating 903, and the filers forming the wall of theshaft 901 do not form a fluid-tight barrier. As a result, and asindicated by arrows 919, the shaft lumen 906 may be used effectively asan inflation lumen because inflation fluid introduced therethrough canpass through an intralumenal portion the multifilar wall of the shaft901 (inside the lumen of the balloon 902) to inflate the balloon 902.However, the wire guide lumen tube 904 most preferably is configured notto allow fluid communication from the shaft lumen 906 or the lumen ofthe balloon 902. Specifically, the wire guide lumen tube 904 isconfigured such that inflation fluid passing through the wall of theshaft 901 into the lumen of the balloon 902 will not escape through thewire guide lumen 904 a. As is also shown in this embodiment, the shaft901 extending through the length of the balloon 902 may providelongitudinal support for the balloon 902.

As is also shown in this embodiment, the balloon 902 and wire guidelumen tube 904 may be mounted to the shaft 901 with a shrink sleeve 908.As shown in FIG. 9D, the sleeve 908 has approximately a figure-eightshape before mounting. The sleeve 908 includes two central apertures(910 and 912) to allow for mounting the sleeve 908 over the wire guidelumen tube 904 and the shaft 901. In this embodiment, after the balloon902 and wire guide tube 904 are assembled to the shaft 901 together withthe sleeve 908, the sleeve 908 may be heated to shrink and form to theassembly of the shaft 901, balloon 902, and wire guide tube 904. FIG. 9Eis a transverse cross section view along line 9E-9E of FIG. 9C thatshows the finished configuration. The sleeve 908 forms to the exteriorsurface of the shaft 901 and leaves open the shaft lumen 906 and thewire guide lumen 904 a. As is shown in FIG. 9A, the sleeve 908 mayextend over and proximally beyond the wire guide tube 904. Accordingly,a wire guide aperture 914 may be skived out or otherwise created toprovide access to the wire guide lumen 904 a. Those of skill in the artwill appreciate that, in lieu of using a sleeve, the coating 903 may beextended to contact the wire guide tube 904 and/or the balloon 902 toprovide a seal of the coating 903 with the wire guide tube 904 and/orthe balloon 902, or that other means for securing the wire guide tube904 and balloon 902 to the shaft 901 may be used within the scope of thepresent invention.

FIGS. 10-10A illustrate an embodiment of a balloon catheter device 1000having an elongate multifilar tube shaft 1001 and being configured foruse without a wire guide. In one aspect, the embodiment of FIG. 10 maybe configured such that it may be manipulated during navigation in thesame manner as a wire guide. An inflation balloon 1002 is disposed nearthe distal end of the device 1000 and is sealed thereto in a manner thatforms a continuously sealed length of the shaft lumen 1006 proximal ofthe balloon 1002 in cooperation with an internal shaft lumen coating1003. In one aspect, the coating 1003 may help to provide a seal thatprevents leakage of inflation fluid from the shaft lumen 1006 throughthe multifilar wall of the shaft 1001. The catheter shaft 1001 mayinclude a tapering diameter that is smaller distally than proximally andprovides for a distal shaft portion that is more flexible than theproximal shaft portion while maintaining desirable pushability andtrackability.

FIG. 10A is an enlarged detail illustration of a distal section of theballoon catheter 1000. As shown in FIG. 10A, the shaft 1001 extendsthrough the balloon 1002 to the distal end 1007. The distal end of theshaft 1001 may be provided with a sealing tip 1009, which preferably hasan atraumatic distal profile. The coating 1003 substantially covers thesurface of the shaft lumen 1006 through the proximal length of the shaft1001 and terminates near the proximal end of the balloon 1002 such thatan intralumenal portion of the shaft 1001 (inside the interior space ofthe balloon, at least part of which forms a lumen of the balloon 1002)does not include the coating 1003, and the filars forming at least thatportion of the wall of the shaft 1001 do not form a fluid-tight barrier.As a result, and as indicated by arrows 1019, the shaft lumen 1006 maybe used effectively as an inflation lumen because inflation fluidintroduced therethrough can pass through the multifilar wall of theshaft 1001 to inflate the balloon 1002. Those of skill in the art willappreciate that a coating may be used on the shaft exterior in additionto or instead of the lumenal shaft coating 1003, and that, if a coatingsare present on both the interior and exterior shaft surfaces, eachcoating may include the same or different materials as the othercoating. In this embodiment, the shaft 1001 also provides longitudinalsupport for the balloon 1002. The shaft portion disposed within theballoon 1002 may include a pair of radio-opaque markers 1017 configuredto allow a user to fluoroscopically visualize the position of theballoon 1002. Suitable radio-opaque markers may include swaged metal(such as, for example, stainless steel, platinum, gold) or a polymerinfused with barium or another radio-opaque material.

In one preferred embodiment, a balloon catheter device such as theballoon catheter 1000 lacking an external wire guide structure may beconstructed such that it may function similar to a wire guide.Specifically, the catheter 1000 may be configured such that it has asmall outer diameter, is sufficiently flexible to pass through a tightcurvature or tortuous passageway, and has pushability and trackabilitysufficient to be navigated through such tightly curved and/or tortuouspathways in the same manner as a wire guide, thereby obviating the needfor a separate wire guide. Those of skill in the art will appreciatethat a preferred outer diameter will be different for differentapplications, but the outer diameter a catheter embodiment configuredfor use in peripheral blood vessels may be in the range of about0.040-0.055 inches, and that the outer diameter may differ along thelength of the catheter embodiment.

In some embodiments, the shaft coating (if any) may be a material otherthan PEBA, and may include the same material or different material thanthe material in a mounting sleeve used to mount a balloon (for example,HDPE, PTFE, PET, polyurethane, polyimide, polyolefin, nylon, or anycombination thereof). The balloon catheters of the present invention maybe adaptable for use with expandable stents as is illustrated, forexample, in FIG. 3B. In the embodiments described above, a flexiblestylet (not shown) may be inserted through the inflation lumen for useduring advancement/navigation of the catheter device to a desiredlocation. Such a stylet may be used to increase stiffness andpushability in a circumstance where that is desirable (such as, forexample, if the catheter is being used to cannulate a lesion). Use of astylet that is shaped (such as, for example, with a curve of up to about70°) may also allow a user to reshape the distal end of the cathetershaft in a manner that may, for example, allow easier indication andnavigation of branch vessels. A preferred stylet will not extend beyondthe distal end of the catheter device.

Another balloon catheter device embodiment 1100 is shown with referenceto FIGS. 11-11G. The catheter device 1100 includes an elongate shaft1107 including a monolayer multifilar tube 1120. An inflation balloon1103 is disposed near the distal end of the device. A hub 1140 isdisposed adjacent the proximal end of the device. FIG. 11A is anenlarged detail illustration of a distal-middle portion of the device1100, showing a magnified longitudinal section view that includes aproximal portion of a wire guide lumen structure 1170 configured for useof the device in a short wire guide configuration. The wire guide lumenstructure 1170 includes a wire guide lumen 1172 that extendssubstantially parallel with an inflation lumen 1101 of the shaft 1107.

In the illustrated embodiment, substantially the entire length of theshaft 1107 may include an outer layer 1150 as a coating. A preferredcoating is a thermoplastic polymer such as, for example, a polyester orpolyether block amide (e.g., PEBA®). A preferred coating will provide adesirable lubricity profile that exhibits low friction duringintroduction of the device through, for example, a blood vessel. Apreferred coating will also provide a fluid-tight seal configured toprevent leakage of pressurized inflation fluid (for example, atpressures in a normal operating range up to about 8-14 atm, andpreferably configured to prevent leakage at pressures exceeding normalranges, for example, up to or exceeding about 27 atm).

A preferred catheter shaft 1107 tapers from a greater proximal outerdiameter (such as, for example, about 0.048 to about 0.052 inches) to alesser distal diameter (such as, for example, about 0.044 to about 0.040inches). Those of skill in the art will appreciate that the lesserdistal diameter may present improved trackability for navigation oftortuous passages.

As is shown in FIGS. 11B and 11C (which is an enlarged detail view ofFIG. 11B), the inflation lumen 1101 of the catheter device 1100 is opento and provides fluid communication with the balloon lumen 1103 a of theballoon 1103. A distal portion 1170 a of the wire guide lumen structure1170 including the wire guide lumen 1172 also extends through theballoon lumen 1103 a and through the distal end of the balloon 1103 to adistal tip 1104. The distal end portion 1170 a of the wire guide lumenstructure 1170 preferably is very flexible (high trackability), and itmay provide an advantage in directing the device 1100 along a wire guide(not shown) through particularly tortuous passages. FIG. 11B also showsthe attachment of the balloon 1103 to the device 1100. Those of skill inthe art will appreciate that, in another embodiment within the scope ofthe present invention, the balloon 1103 may be attached to the tube 1120and configured such that the distal wire guide lumen structure portion1170 a extends exterior (of the balloon lumen 1103 a) and adjacent theballoon 1103.

FIG. 11D shows a transverse cross-section of a dual-lumen thermosetsleeve 1105, which has a generally figure-8 cross-section and includesan upper lumen 1105 a and a lower lumen 1105 b. The sleeve 1105preferably is constructed of a thermoplastic binder material such as,for example, a polyolefin, polyester or polyether block amide (PEBA), orother appropriate polymeric material having thermoplastic materialssuitable for helping to form the wire guide lumen structure 1170 and toattach it to the tube 1120. As depicted in FIGS. 11E-11F (each of whichrepresents a transverse cross-sectional view along line 11E-11E of FIG.11A), the upper lumen 1105 a of the sleeve 1105 defines the wire guidelumen 1172. The wire guide lumen 1172 may include a wire guide lumenliner 1172 a, which preferably is made of a lubricious polymer that canform a thin wall with high strength such as, for example, PTFE,polyethylene, polyimide, or a similar material. In one aspect, the liner1172 a may help prevent fluid from leaking from the inflation lumen 1101through pores of the tube 1120 into the wire guide lumen 1172.Preventing inflation fluid from leaking out of the inflation lumen ispreferable for at least the reason that a substantially patent fluidlumen is required to allow passage of inflation fluid at a pressure andrate desired for proper inflation and deflation of the balloon. Inanother aspect, the portion of the sleeve 1105 between the sleeve lumens1105 a and 1105 b may be provided with a desired thickness such as, forexample, about 0.001 inches to minimize the likelihood of cross-lumencommunication between the inflation lumen 1101 and wire guide lumen1172.

The lower lumen 1105 b surrounds the tube 1120. The outer layer coating1150 of the device may extend over and surround the exterior of thesleeve 1105. As shown in FIGS. 11E-11F, the thermoset sleeve 1105 hasbeen heated to conform around the wire guide lumen 1172 and tube 1120.FIG. 11E shows the sleeve 1105 as having been formed with a roundcross-section, and FIG. 11F shows the sleeve 1105 as having been formedwith an out-of-round cross-section. The latter configuration ispreferred when the device 1100 is to be used in conjunction with a guidesleeve (not shown) through which contrast fluid may be injected, becausethe out-of-round profile will more readily permit contrast fluid to flowthrough a circular-cross-section guide sheath lumen and around thesleeve 1105. However, it is preferable that the cross-sectional heightnot be greatly different than the cross-sectional width.

A wire guide aperture 1109 is described with reference to FIGS. 11A and11G (which is a transverse cross-sectional view of FIG. 11A along line11G-11G). In order to facilitate use of the catheter device 1100 in ashort wire configuration, a wire guide aperture 1109 is provided nearthe proximal end of the wire guide lumen structure 1170. The wire guideaperture 1109 may be formed by skiving an opening through the outerlayer 1150, upper surface of sleeve 1105, and (if present) wire guidelumen liner 1172 a. This aperture 1109 will, for example, allow a wireguide (not shown) directed from the distal end 1104 through the wireguide lumen 1172 to exit. As described above, mounting the device 1100onto a wire guide in this manner may facilitate rapid introductionand/or exchange of the device 1100 along the wire guide. In order toprovide additional protection against cross-lumen leakage in theaperture region, an additional barrier 1105 c may be provided around thecircumference of the shaft 1107 along a shaft region adjacent theaperture 1109. The barrier 1105 c preferably will be formed of ahigh-strength polymer that preferably is impermeable to inflation fluidsuch as, for example, a polyether block amide or similar material.

EXAMPLE 1

An exemplary method of making a wire-guided balloon catheter 1200 isdescribed with reference to FIGS. 12A-12K. Those of skill willappreciate that this and other embodiments may be constructed usingalternative methods within the scope of the present invention. As shownin FIG. 12A, a multifilar tubular shaft 1202 is provided, including amonolayer tubular shaft of ten filers coiled together to form a shaftwall 1204 defining a shaft lumen 1206. The shaft 1202 includes aproximal end 1202 a and a distal end 1202 b, and it has desirablepushability and trackability characteristics, with a structure thattapers from a proximal outer diameter of about 0.05 inches to a distaldiameter of about 0.04 inches. (NOTE: FIGS. 12A-12K, along with allother figures of the present application, may not be drawn to scale).Next, as shown in FIG. 12B, a PEBA barrier sleeve 1208 is placed arounda distal region of the shaft wall 1204 and heated to sealingly shrinkaround it (1204).

Then, as depicted in FIG. 12C, an elongate dual-lumen sleeve 1210 isprovided. The dual-lumen sleeve 1210 includes a lower lumen 1212 and anupper (wire guide) lumen 1214. An upper lumen portion 1214 a of thesleeve 1210 extends distally beyond a lower lumen portion 1212 a of thesleeve 1210. FIG. 12C shows the dual-lumen sleeve 1210 as having beenmounted onto the shaft wall 1204 of the shaft 1202 by sliding a distalportion of the shaft 1202 into the lower lumen 1212 until the distalshaft end 1202 b is near the distal end of the lower lumen portion 1212a.

FIG. 12D shows a PTFE wire guide lumen liner 1218 provided on a firstmandrel 1218 a. The liner 1218 will be directed into the upper (wireguide) lumen 1214 until its (1218) proximal end is adjacent the proximalend of the upper (wire guide) lumen 1214. Next, as shown in FIG. 12E, atubular PEBA thermoplastic sheath 1220 is directed over the entirelength of the shaft 1202 such that it also encircles that portion of thedual-lumen sleeve 1210 around the distal region of the shaft 1202. Then,as illustrated in FIG. 12F, after the assembly is heated, the sheath1220 shrinks around the shaft length to form a sealing coating 1220along the length of the shaft 1202 and fusing the dual lumen sleeve 1210to the shaft wall 1204 and the liner 1218. During the heat-shrink step,a second mandrel 1222 is provided through the shaft lumen 1206 toprevent it from becoming occluded by any coating material that may seepthrough the shaft wall.

Next, as depicted in FIG. 12G, a wire guide aperture 1230 is skived nearthe proximal end of the upper (wire guide) lumen 1214 by cutting orotherwise incising through the sheath 1220, the sleeve 1210, and theliner 1218. FIG. 12H shows that the first mandrel 1218 a (or a differentmandrel, not shown) is directed through the wire guide aperture 1230 ina manner that compresses a portion of the dual lumen sleeve 1210immediately proximal of the wire guide aperture 1230. The compressedregion is heated and, as shown in FIG. 12J, substantially fuses to forma proximal ramped surface 1230 a as a proximal portion of the wire guideaperture 1230.

As illustrated in FIG. 12I, the proximal end of a balloon 1280 isattached (preferably by a heat seal or equivalent means) to the assemblyadjacent the distal shaft end 1202 b such that the upper lumen portion1214 a of the sleeve 1210 extends through the lumen 1282 and distal endof the balloon 1280. The distal end of the balloon 1280 is sealed (alsopreferably by a heat seal or equivalent means) to the upper lumenportion 1214 a of the sleeve 1210, which houses the wire guide lumen1214. The PTFE wire guide liner 1218 does not need to extend completelyto the distal end of the upper lumen portion 1214 a of the dual-lumensleeve 1210. The balloon 1280 can be compressed and folded, and—ifdesired—a stent 1290 mounted thereto as shown in FIG. 12J. And, as shownin FIG. 12K, a hub 1295 may be mounted to the proximal shaft end 1202 a.In another embodiment of this method, the longitudinal shape of thatupper lumen portion that is distal of the multifilar shaft may bemodified to align generally with a longitudinal axis of that multifilarshaft or of the combined multifilar shaft and outer sleeve 1210 in amanner similar to that shown in FIG. 5C.

In another aspect of the present invention, it should be appreciatedthat, for many embodiments described herein, the multifilar tube may besubstituted with a helically-cut or helically-scored hypotube (such as,for example, stainless steel or nitinol hypotube), collectively referredto herein as helically-scored hypotube. Helically-scored hypotube iswell known in the catheter art, and those of skill in the art willappreciate that catheter embodiments including a tube ofhelically-scored hypotube rather than an elongate monolayer multifilartube may be practiced within the scope of the present invention. Forexample, one embodiment may include an elongate helically-cut hypotube,said hypotube including a proximal tube end, a distal tube end, and alongitudinal tube lumen extending therebetween. In such an embodiment aninflatable balloon may be disposed adjacent the distal tube end suchthat a lumen of the balloon is in fluid communication with thelongitudinal tube lumen, wherein the tube includes a substantiallypatent path of fluid communication between a proximal tube portion andthe balloon lumen. Such an embodiment may also include a dual-lumensleeve structure disposed adjacent the distal tube end, said dual-lumensleeve structure comprising a first sleeve lumen and a second sleevelumen, wherein the first sleeve lumen includes a wire guide lumen andextends distally beyond the distal tube end. The second sleeve lumenincludes a tube-bonding lumen through which is disposed a tube portionadjacent the distal tube end. A coating may be provided that coverssubstantially the exterior surfaces of the tube and the sleevestructure, and provides a patent fluid communication path along the tubelumen between the proximal tube end and the balloon lumen. Inparticular, the balloon is connected near its proximal end to the tubeand to the sleeve structure, and is also connected distally to thesleeve structure such that at least a portion of the sleeve structureextends through the balloon lumen. In this manner the first sleeve lumenextends distally beyond a distal end of the balloon. Furthermore, a wireguide aperture may be proximally disposed on the wire guide lumen and beconfigured to provide passage therethrough for a wire guide.Additionally, a wire guide lumen-lining layer may be provided in thewire guide lumen. Also, a sleeve structure may be provided around thehypotube adjacent the wire guide aperture in order, for example, toprovide enhanced structural strength and to decrease the likelihood thatinflation fluid may travel from the tube lumen to the wire guide lumen.This embodiment may also be used with a stent or other expandabledevice. Those of skill in the art will note that this embodiment may beunderstood and practiced, including a method of making the embodiment,with reference to FIGS. 11-12K, wherein helically-cut hypotube is usedrather than a multifilar tube, and that other embodiments describedherein may similarly be adapted for use with helically-cut hypotubewithin the scope of the present invention.

A different embodiment of a balloon catheter shown as a multifilar cablecatheter 1400 configured for short wire/rapid-exchange use is describedwith reference to FIGS. 13-13C, 14, and 15. The catheter device 1400includes a proximal-end hub 1402 with a fitting 1404 (e.g., a Luer-typefitting for an inflation fluid source). An elongate shaft including aproximal multifilar cable tube 1406 extends distally from the hub 1402.An intervening strain relief portion 1405 may be provided as well. Themultifilar cable tube 1406 preferably is formed as a continuousmonolayer or multi-layer tube of laterally-touching coiled filars, eachhaving a length that does not cross over itself nor other filars.Specifically, it is preferably that adjacent filars of any individuallayer are non-interlaced/non-overlapping (i.e., not braided, woven,interlaced or otherwise overlapping/engaging beyond a substantiallylateral contact). Suitable multifilar tubing may be obtained, forexample, from Asahi-Intecc (Newport Beach, Calif.) or from Fort WayneMetals (Fort Wayne, Ind.). Materials and Methods of manufacturingsuitable multifilar tubing are described in U.S. Pat. No. 7,117,703(Kato et al.), which is incorporated herein by reference. Thisconfiguration of cable tubing 1406 provides desirable pushability andtrackability. The tubing 1406 defines a fluid-patent multifilar tubelumen 1410 configured as the proximal portion of an inflation lumen. Insome suitable configurations, filars of the multifilar tube may beswaged to create smooth inner and outer diameter surfaces of the tubeformed thereby.

A jacketing material 1408 sealingly coats the outer surface of the cabletube 1406. The jacketing 1408 is clearly illustrated in FIG. 13A, whichis a transverse cross section view of FIG. 13 along line A-A. Thelumen-facing surface of the tube 1406 in FIG. 13A is shown as beingswaged to provide a generally smooth surface for the lumen 1410, andthose of skill in the art will appreciate that other interior andexterior portions of the tube 1406 may also be swaged in this or asimilar manner. Suitable materials for the jacketing 1408 includeheat-shrink tubing such as, for example, a polyether block amide barriermaterial (e.g., PEBA) that is thermoformed to the exterior of the cabletube to provide a sealing coating and maintain fluid patency of thecable tube 1406 during introduction of inflation fluid through theinflation lumen 1410. Other materials that may be used in the jacketinginclude HDPE, PTFE, PET, polyurethane, polyimide, polyolefin, nylon, orany combination thereof (including combinations with PEBA). In certainembodiments, it may be advantageous to roughen the external surface 1411of the cable tube 1406 (e.g., by sanding, blasting, or any othertechnique that would roughen and/or otherwise increase the textureand/or surface area to enhance frictional contact between the jacketing1408 and tube 1406). This roughening provides enhanced strength ofattachment without affecting weight or diameter in the manner thatadhesive or ancillary connectors would, while also being configured toprovide the desirable trackability and pushability of these embodiments.The external tube surface 1411 is also shown as being swaged in a mannertapering distally, but it should be appreciated that the surface 1411may be swaged in a substantially linear fashion parallel to thelongitudinal axis of the tube, and that the inner tube diameter definingthe lumen 1410 may also be swaged (including for any lengthwise portionof the tube 1406). Although the texture is not visible in the drawing,one or both of the surfaces 1406, 1411 may be roughened to enhance theconnection with adjoining surfaces.

A distal portion of the elongate shaft is formed of a polymer shaft tube1420 secured to the cable tube portion 1406. A proximal polymer tube endpreferably is attached directly to the polymer barrier coating formed bythe jacketing material 1408 adjacent the distal cable tube end. Incertain embodiments, it may be advantageous to roughen the externalsurface 1409 of the jacketing material 1408 (e.g., by sanding, blasting,or any other technique that would roughen and/or otherwise increase thetexture and/or surface area to enhance frictional contact between thejacketing 1408 and polymer shaft tube 1420), and at least one or more ofthe polymer tube end, cable tube end, and/or jacketing material may beroughened for this reason. The polymer tube 1420 preferably is formedfrom materials having a durometer that provides substantially similarflexibility, trackability, and pushability as the coated cable tubeportion, but—in certain embodiments—the distal polymer tube portion maybe more flexible than a more proximal cable tube portion. In thismanner, the transition region, intermediate in the shaft length, wherethe coated cable tube portion ends and the polymer tube portion beginsmost preferably will not provide a flex point where kinking or bendingis likely to occur in the manner of some prior catheter devices.

For example, a cable tube made of nitinol or stainless steel may have anouter diameter of about 20-100 mil (about 0.51-2.54 mm), with apreferred range of about 30-80 mil (about 0.76-2.03 mm) and an innerdiameter about 20-80 mil (about 0.51-2.03 mm). In one example, one maybegin with a 12-filar stainless steel cable tube having an outerdiameter of 35 mil (0.89 mm) and swage it to 33 mil (0.84 mm), andprovide it with a 4 mil (0.1 mm) wall liner, and a 21 mil (0.53 mm)inner diameter. The distal polymer shaft 1420 may be formed of nylon,PEBA, or blend of nylon with PEBA and PEBA heat-shrink (which should,for all purposes of this application be considered as included whereverPEBA is mentioned), polyethylene, or other suitable materials,preferably having a durometer of about 76 D, and preferably is formed asan extruded or molded dual-lumen tubing. Stated differently, the polymertube portion provides very similar properties as compared to the cabletube portion in the region immediately adjacent the cable tube portion.This construction provides cost savings in materials as well asproviding a kink-resistant construction with desirable pushability andtrackability. Two different embodiments of a transition region betweenthe cable tube shaft portion and the polymer tube shaft portion areillustrated with reference to FIGS. 14 and 15, each of which isillustrated in a longitudinal section view along line X-X of FIG. 13.

The distal polymer tube portion of the elongate shaft of the device 1400is configured as a dual-lumen catheter. In this manner, the overalldevice 1400 includes a proximal single-lumen cable tube catheter portion1406 and a distal dual-lumen polymer catheter portion 1420. A transversecross-sectional view of the transition region from the single to thedual-lumen portion is shown in FIG. 13B which is a transverse crosssectional view taken along line B-B of FIG. 13. A fluid-patent polymertube inflation lumen 1422 of the polymer tube 1420 sealingly encompassesthe distal end of the jacketed cable tube 1406. A wire guide lumen 1424begins at an angled wire guide port 1426. A wire guide 1430 is shownextending through the wire guide lumen 1424 and the wire guide port1426. The inflation lumen 1410 of the proximal cable tube portion of thedevice 1400 continues a path of fluid-patent communication into andthrough the distal polymer tube inflation lumen 1422, forming acontinuous inflation lumen. A transverse distal cross sectional view ofthe polymer catheter portion 1420, distal of the single-lumen cable tubecatheter portion 1406 is shown in FIG. 13C, which is taken along lineC-C of FIG. 13. As shown therein, the inflation lumen portion mayinclude a non-circular cross-section.

A balloon 1450 is secured at its proximal end to the polymer catheterportion 1420. The polymer tube inflation lumen 1422 terminates where thepolymer catheter portion 1420 joins the balloon 1450. The polymer tubeinflation lumen 1422 is in patent fluid communication with a balloonlumen 1452. An intact, fluid patent portion of the polymer catheter 1420extends through the balloon lumen 1452, providing a continuation of thewire guide lumen 1424 to the distal end of the balloon 1450, which isshown with the wire guide 1430 extending therefrom. As shown in FIG. 13,radio-opaque marker bands 1435 preferably are included on or in the wireguide lumen portion of the polymer catheter 1420 that extends throughthe balloon lumen 1450. The marker bands 1435 preferably are orientedparallel with the ends of an intermediate expandable balloon region,such that a user can fluoroscopically determine the location of theballoon 1450 for desired deployment.

The construction of the transition between the cable tube shaft portion1406 and the polymer tube shaft portion 1420 may be embodied in at leasttwo different ways. A first embodiment is described with reference toFIG. 14, which is presented as a longitudinal section view along lineX-X of FIG. 13. The cable tube 1406 is covered with a sealing polymerjacket 1408. The jacket material 1408 extends distally beyond a distalend of the cable tubing 1406, providing a smooth transition between thecable tube lumen 1410 and the polymer tube lumen 1422. The polymer tube1420 preferably is heat-bonded together with the jacketed cable tube1406 by inserting a mandrel-type component (e.g., a building wire)through the lumens of both components (1410, 1422), then inserting thedistal end of the jacketed cable tube 1406 into the proximal end of thepolymer tube inflation lumen 1422, then heating the joint to form asecure sealed connection (during which it is preferable to provide amandrel-type component through the wire guide lumen 1424 to maintain itspatency). Although FIG. 14 uses different cross-hatching patterns toshow the “pre-bonding” structure of the jacketing 1408 and the polymertubing 1420, the “post-bonding” structure preferably will have thesecomponents melted together such that their structure will be relativelyseamless. For purposes of illustration, the outer diameter of the distalpolymer portion of the device 1400 is shown as being significantlygreater than the proximal cable catheter portion, but it preferably willhave an outer diameter that is nearly the same as, or only slightlygreater than that of the proximal portion. The proximal end of thepolymer catheter section 1420 preferably tapers slightly to present anatraumatic profile that will be easily navigable in proximal and distaldirections through other lumens (e.g., body lumens, tool lumens such asof an introducer or endoscope).

A second embodiment of the transition region is described with referenceto FIG. 15, which is presented as a longitudinal section view along lineX-X of FIG. 13. The cable tube 1406 is covered with a sealing polymerjacket 1408. The jacket material 1408 terminates at the distal end ofthe cable tubing 1406, providing a smooth transition between the cabletube lumen 1410 and the polymer tube lumen 1422. The polymer tube 1420preferably is heat-bonded together with the jacketed cable tube 1406 byinserting a mandrel-type component (e.g., a building wire) through thelumens of both components (1410, 1422), then inserting the distal end ofthe jacketed cable tube 1406 into the proximal end of the polymer tubeinflation lumen 1422, and heating the joint to form a secure sealedconnection (during which it is preferable to provide a mandrel-typecomponent through the wire guide lumen 1424 to maintain its patency).The direct attachment between the polymer tube inflation lumen 1422 andthe jacket of the cable tube 1406 preferably is a heat-set attachmentsubstantially fusing the two together. This construction provides asmooth internal diameter of the inflation lumen that is substantiallyconsistent between the cable tube lumen 1410 and the polymer tube lumen1422. (And, it should be appreciated that, although the drawing figureuses different cross-hatching to show the different components, they maybe constructed of the same materials and form a seamless, continuouslayer).

Although FIG. 15 uses different cross-hatching patterns to show the“pre-bonding” structure of the jacketing 1408 and the polymer tubing1420, the “post-bonding” structure preferably will have these componentsmelted together such that their structure will be relatively seamless.For purposes of illustration, the outer diameter of the distal polymerportion of the device 1400 is shown as being significantly greater thanthe proximal cable catheter portion, but it preferably will have anouter diameter that is nearly the same as, or only slightly greater thanthat of the proximal portion. The proximal end of the polymer cathetersection 1420 preferably tapers slightly to present an atraumatic profilethat will be easily navigable in proximal and distal directions throughother lumens (e.g., body lumens, tool lumens such as of an introducer orendoscope).

The cable tube 1406 and/or the polymer tube 1420 may be tapered to havea smaller distal outer diameter and increase flexibility. The durometerof the polymer tube portion 1420 may be selected such that it providesflexibility, trackability, and pushability that are substantially thesame as the proximal cable tube portion 1406 (together with its jacket1408). The wire guide aperture 1426 may be positioned near, but proximalof the distal end of the cable tube portion 1406. The durometer of thedistal polymer tube portion 1420 may be selected such that itsflexibility, trackability, and pushability are substantially the same asthe proximal cable tube portion 1406 when a wire guide is presentthrough the wire guide lumen 1424. Those of skill in the art willappreciate that less material may be used in this latter construction,thereby presenting a cost savings, while providing a catheter devicethat, as used, provides a substantially consistent flexibility,trackability, and pushability along its entire length during its actualuse conditions when it is introduced along a wire guide, or that may beconstructed to provide enhanced flexibility nearer the distal end. Theballoon 1450 preferably is heat-sealed or attached by adhesive to thepolymer tube 1420. The balloon may be constructed of essentially thesame polymer as the polymer tube, such that it can be fused seamlesslywith the polymer tube.

In certain preferred embodiments of a multifilar cable balloon catheter1400, the distal polymer dual-lumen portion may have an outside diameterof about 45 mil (about 1.14 mm) with an inside/lumen diameter of about21 mil (about 0.53 mm) for the inflation lumen and an inside/lumendiameter of about 18 mil (about 0.46 mm) to about 21 mil (about 0.53 mm)for the wire guide lumen. As is described with reference to otherembodiments above, the cable tube portion and/or the polymer tubeportion may be tapered from a larger proximal diameter to a smallerdistal diameter to enhance the navigability of the distal portionthrough more tortuous passages.

In certain embodiments, it may be desirable to provide a large inflationlumen through the catheter body portions to supply fluid communicationwith a balloon lumen that will provide for desirably short inflation anddeflation times during a procedure using a balloon catheter. Theembodiments described above may provide this, but the cable tubeproximal shaft (e.g., tubing 1406) may limit the flow rate therethroughas its jacketed outer diameter must fit into the flow-rate-optimizedhalf-round lumen of the distal lumen portion (see, e.g., upper/inflationlumen 1422 of dual-lumen portion 1420 in FIG. 13C, which inflation lumenis in fluid communication with balloon lumen 1452). In other words, theouter diameter of the overall device is limited by the anatomy throughwhich it will travel such as, for example, blood vessels or other bodypassages. This restricts the available internal diameter of theinflation lumen, particularly when a wire guide lumen is also provided.The transitional portion at the distal end of the cable tube portion ofsome catheter embodiments will have an internal diameter that is limitedas a “choke point” of sorts. A structure and method is described belowfor providing attachment of a proximal jacketed multifilar cable tubehaving a larger internal diameter to a dual-lumen connector member(e.g., similar and/or analogous to polymer tube 1420 shown and describedabove). In this manner, a generally circular cross-section lumen of aproximal alloy tube may provide about the same (that is, slightlygreater or less, exactly the same, substantially the same, or verynearly the same) cross-sectional area as a flow-optimized lumen of adistal inflation lumen of a dual-lumen catheter portion. Regardless ofthe size and contours of cross-sectional area provided, it will bepreferable that the flow rate provided by the proximal inflation lumenwill provide the same or a similar flow rate as the distal inflationlumen.

In one embodiment of a balloon catheter 1500, shown in FIGS. 16A-16B, acable tube 1506 is provided. It preferably is sized such that itsinflation lumen 1510 will provide for a flow-rate closely similar to theflow-rate provided by flow-rate-optimized half-round lumen 1522 (see,e.g., lumen 1422 in FIG. 13C) of the distal dual-lumen portion 1520. Inorder to avoid sacrificing flow rate-consuming space of the distalinflation lumen 1522, a cannula configured as a short thin-walledconnector tube 1523 is provided. As shown in FIG. 16B, the thin-walledconnector tube 1523 is configured for insertion into the inflation lumen1522 of the distal dual-lumen tube 1520. When the catheter 1500 isassembled as shown in FIG. 16B, a patent path of fluid communication isprovided between the cable tube inflation lumen 1510 and the distalmember inflation lumen 1522. The cable tube 1506 has a larger outerdiameter and inner diameter in proportion to the distal member inflationlumen 1522 when compared—for example—with the embodiments shown in FIGS.14-15. As such, in this embodiment (and those of FIGS. 17-19B) the innerdiameters of the cable tube 1506 and the distal inflation lumen 1522 aremore similar and provide for more rapid flow during inflation and/ordeflation of a balloon.

The distal dual-lumen portion 1520 is shown with a wire guide lumen1524, illustrated with a wire guide 1530 disposed slidably therethrough.The thin-walled connector tube 1523 may be fused to the inner diameterof the cable tube lumen 1510, but preferably is laser welded at thedistal end of the cable tube body 1506. A distal portion of thethin-walled connector tube 1523 may be roughened or otherwise treated toincrease its surface area and/or frictional profile to improve itsbonding with the jacketing 1508 and/or the distal dual-lumen tube member1520. That distal member 1520 may be constructed of heat-shrink PEBAX,nylon-PEBAX blend, or another material that may be bonded (e.g.,thermally by heat-shrink, with adhesive, or by some other connectingmeans) with the thin-walled connector tube 1523, and—in someembodiments—with a distal end portion of the proximal tube body 1506.The two portions shown may be fused and/or otherwise bonded together by,for example, adhesive, welding, soldering, an integrated or removableheat-shrink sleeve, or other attachment means that will provide a stableconnection configured for use in a medical catheter.

In another embodiment of a balloon catheter 1700, shown in FIGS. 17-18C,a cable tube 1706 covered with jacketing material 1708 (such as, forexample, heat-shrinkable PEBAX) is provided. It preferably is sized suchthat its inflation lumen 1710 will provide for a flow-rate closelysimilar to the flow-rate provided by flow-rate-optimized half-roundlumen 1722 of the distal lumen portion 1720. Similar to the embodimentof FIGS. 16A-16B, a short thin-walled connector tube 1723 is provided.Also, similar to the embodiment shown in FIG. 16B, the thin-walledconnector tube 1723 is configured for insertion into the inflation lumen1722 of the distal dual-lumen tube 1720. When the catheter 1700 isassembled as shown in FIGS. 17B-18C, a patent path of fluidcommunication will be provided between the cable tube inflation lumen1710 and the distal member inflation lumen 1722. The cable tube 1706will generally have a larger outer diameter and inner diameter inproportion to the distal member inflation lumen 1722 when compared—forexample—with the embodiments shown in FIGS. 14-15. As such, in thisembodiment, the inner diameters of the cable tube 1706 and the distalinflation lumen 1722 are more similar and provide for more rapid flowduring inflation and/or deflation of a balloon (although it will beappreciated with the shape of the distal lumen 1722, that its majorheight/inner diameter may be less than the inner diameter of theproximal inflation lumen 1710 for the major lengths of each.

The distal dual-lumen portion 1720 is shown with a wire guide lumen1724. A proximal portion of its inflation lumen 1722 is shown as havingbeen expanded (e.g., by insertion of a mandrel, which may be heated). Inthis manner, a larger inner diameter “entry portion” of the distalinflation lumen 1722 is provided to receive the proximal catheterportion in a manner that provides a generally circular/cylindricalcavity without reducing the overall inner diameter that will beavailable for fluid flow in a final assembled catheter 1700. FIG. 17C, atransverse section view along line 17C-17C, shows the expanded/re-shaped“entry portion” of the distal lumen 1722, which has a generally circularcross-sectional geometry (not to scale, as the cross-sectional area ofthe proximal inflation lumen 1710 preferably will provide for the sameor about the same flow rate as the cross-sectional area of the distalinflation lumen 1722), and FIG. 17D, a transverse section view alongline 17D-17D, shows the unaltered portion of the distal lumen 1722,which has a generally follow-optimized half-round cross-sectionalgeometry. The cross sectional area of both may be about the same, andboth will preferably provide about the same flow rate under theconditions of use associated with inflating and/or deflating a dilationballoon. The thin-walled connector tube 1723 preferably is fused to thedistal end and/or the inner diameter of the cable tube lumen 1710. Adistal portion of the thin-walled connector tube 1723 may be roughenedor otherwise treated to increase its surface area and/or frictionalprofile to improve its bonding with the jacketing material 1708. Thatdistal dual-lumen member 1720 may be constructed of heat-shrink PEBAX oranother material that may be bonded (e.g., thermally by heat-shrink,with adhesive, or by some other connecting means) with the jacketingmaterial 1708. A preferred material is nylon-PEBAX blend.

When assembling the complete catheter 1700 by inserting the distal endof the jacketed proximal portion into the upper/inflation lumen 1722 ofthe dual-lumen member 1720 (as shown in FIG. 17B), it may be desirableto provide a mandrel (not shown) through the proximal and distalinflation lumens 1710, 1722 so that a method step of fixedly attachingthose elements (e.g., by thermoset, melt-fusing, sonic welding, applyingadhesive, and/or any other method appropriate for the materials) willnot occlude those lumens. A mandrel may also be provided through thewire guide lumen 1724 during assembly. As shown in FIGS. 17A-17B, thejacketing material 1708 may extend beyond the distal end of theconnector tube 1723. This may help to secure the components together andprovide a smooth transition between the joined inflation lumens 1710,1722.

As shown in FIGS. 18-18C (with reference to the longitudinal sectionview of FIG. 17B), an assembled catheter device 1700 includes aproximal-end hub 1702 with a fitting 1704 (e.g., a Luer-type fitting foran inflation fluid source). An elongate shaft including a proximal alloytube 1706 extends distally from the hub 1702. An intervening strainrelief portion 1705 may also be provided. When embodied as a multifilarcable tube, the tube 1706 preferably will be formed as a continuousmonolayer or multi-layer tube of laterally-touching coiled filars, eachhaving a length that does not cross over itself nor other filars. Thisconfiguration will provide desirable pushability and trackability. Thetubing 1706 defines a fluid-patent proximal tube lumen 1710 configuredas the proximal portion of an inflation lumen that includes a distalinflation lumen portion 1722, which terminates at and is in fluidcommunication with a balloon lumen 1752. In some suitableconfigurations, filars of the multifilar tube may be swaged to createsmooth inner and/or outer diameter surfaces of the tube formed thereby.

A jacketing material 1708 sealingly coats the outer surface of the cabletube 1706 and the exposed portion (outside the tube body 1706) of thethin-walled cannula 1723. The jacketing 1708 is shown in FIG. 18A, whichis a transverse cross-section view of FIG. 18 along line A-A. Suitablematerials for the jacketing 1708 include heat-shrink tubing such as, forexample, a polyether block amide barrier material (e.g., PEBAX) that isthermoformed to the exterior of the cable tube to provide a sealingcoating and maintain fluid patency of the cable tube 1706 duringintroduction of inflation fluid through the inflation lumen 1710. Othermaterials that may be used in the jacketing include HDPE, PTFE, PET,polyurethane, polyimide, polyolefin, nylon, or any combination thereof(including combinations with PEBAX).

In certain embodiments, it may be advantageous to roughen the externalsurface of the cable tube 1706 and/or cannula 1723 (e.g., by sanding,blasting, or any other technique that would roughen and/or otherwiseincrease the texture and/or surface area to enhance frictional contactbetween the jacketing 1708 and underlying tube and/or cannula). Thisroughening provides enhanced strength of attachment without affectingweight or diameter in the manner that adhesive or ancillary connectorswould, while also being configured to provide the desirable trackabilityand pushability of these embodiments. The inner tube diameter definingthe lumen 1710 may be swaged for any lengthwise portion of the tube 1706(see, e.g., FIG. 13B). Although the texture is not visible in thedrawing, one or both of the external surfaces of the cable tube 1706and/or cannula 17233 may be roughened to enhance the connection withadjoining surfaces.

A distal portion of the elongate shaft is formed of the dual-lumenpolymer shaft tube 1720 secured to the cable tube portion 1706 in themanner described above with reference to FIGS. 17A-17B, where thejacketed cannula 1723 is inserted into the distal lumen 1722. It may beadvantageous to maintain a larger inner diameter functional lumen byusing a mandrel or other appropriate means to expand a proximal portionof the distal lumen 1722, as shown in FIG. 17A. In this manner, theinner diameter of the cannula 1723—even though generally circular insection—will provide a path of fluid communication that is closer insize to the modified half-round distal lumen 1722 (see, e.g., FIG. 18C)than other configurations. A proximal polymer tube end preferably isattached directly to the polymer barrier coating formed by the jacketingmaterial 1708 overlying the distal end of the cannula 1723.

In certain embodiments, it may be advantageous to roughen an externalsurface of that jacketing material 1708 (e.g., by any appropriatechemical and/or mechanical technique that would roughen and/or otherwiseincrease the texture and/or surface area to enhance frictional contactbetween the jacketing 1708 and the distal dual-lumen tube 1720). Asdescribed throughout this specification, any surface intended to contactand be securely fused or otherwise attached to another material may beroughened for this reason. The polymer tube 1720 preferably is formedfrom materials having a durometer that provides substantially similarflexibility, trackability, and pushability as the coated cable tubeportion, but—in certain embodiments—the distal polymer tube portion maybe more flexible than a more proximal cable tube portion. In thismanner, the transition region, intermediate in the shaft length, wherethe coated cable tube portion ends and the polymer tube portion beginsmost preferably will not provide a flex point where kinking or bendingis likely to occur in the manner of some prior catheter devices.

For example, a cable tube made of nitinol or stainless steel may have anouter diameter of about 20-100 mil (about 0.51-2.54 mm), with apreferred range of about 30-80 mil (about 0.76-2.03 mm) and an innerdiameter about 20-70 mil (about 0.51-2.03 mm) that is less than theouter diameter. In one example, one may begin with a 12-filar stainlesssteel cable tube having an outer diameter of 35 mil (0.89 mm), swage itto 33 mil (0.84 mm), and provide it with a 4 mil (0.1 mm) wall liner,and a 21 mil (0.53 mm) inner diameter. The distal polymer shaft 1720 maybe formed of nylon, PEBAX, a blend of nylon with PEBAX, and/or PEBAXheat-shrink (which should, for all purposes of this specification beconsidered as included wherever PEBAX is mentioned), polyethylene, orother suitable materials, preferably having a durometer of about 76 D,and preferably is formed as an extruded or molded dual-lumen tubing.Stated differently, the polymer tube portion provides very similarproperties as compared to the cable tube portion in the regionimmediately adjacent the cable tube portion. This construction willprovide cost savings in materials as well as providing a kink-resistantconstruction with desirable pushability and trackability. The transitionregion between the cable tube shaft portion and the distal, dual-lumenpolymer tube shaft portion are illustrated with reference to FIGS. 17Aand 17B, each of which is illustrated in a longitudinal partial-sectionview along line X-X of FIG. 18.

The distal polymer tube portion of the elongate shaft of the device 1700is configured as a dual-lumen catheter. In this manner, the overalldevice 1700 includes a proximal single-lumen cable tube catheter portion1706 and a distal dual-lumen polymer catheter portion 1720. A transversecross-sectional view of the transition region from the single to thedual-lumen portion is shown in FIG. 18B which is a transverse crosssectional view taken along line B-B of FIG. 18 showing the jacketedcannula 1723 and distal body 1720. A fluid-patent polymer tube inflationlumen 1722 of the polymer tube 1720 sealingly encompasses the distal endof the cannula 1723. A wire guide lumen 1724 begins at an angled wireguide port 1726. A wire guide 1730 is shown extending through the wireguide lumen 1724 and the wire guide port 1726. The inflation lumen 1710of the proximal cable tube portion of the device 1700 continues a pathof fluid-patent communication into and through the distal polymer tubeinflation lumen 1722, forming a continuous inflation lumen. A transversedistal cross sectional view of the polymer catheter portion 1720, distalof the single-lumen cable tube catheter portion 1706 is shown in FIG.18C, which is taken along line C-C of FIG. 18. As shown therein, theinflation lumen portion may include a non-circular cross-section.

A balloon 1750 is secured at its proximal end to the dual-lumen catheterportion 1720. The polymer tube inflation lumen 1722 terminates where thepolymer catheter portion 1720 joins the balloon 1750. The polymer tubeinflation lumen 1722 is thereby in patent fluid communication with aballoon lumen 1752. A fluid-patent portion of the polymer catheter 1720extends through the balloon lumen 1752, providing a continuation of thewire guide lumen 1724 to the distal end of the balloon 1750, which isshown with the wire guide 1730 extending therefrom. As shown in FIG. 18,radio-opaque marker bands 1735 preferably are included on or in the wireguide lumen portion of the polymer catheter 1720 that extends throughthe balloon lumen 1750. The marker bands 1735 preferably are orientedparallel with the ends of an intermediate expandable balloon region,such that a user can fluoroscopically determine the location of theballoon 1750 for desired deployment.

FIGS. 19A-19B show a variation of the embodiment of FIGS. 17A-180. Thethin-walled connector tube 1723 may include one or more helical/spiralscores 1729 (e.g., on internal and/or external surfaces) and/or cuts(extending through at least one wall portion) configured to enhance itsflexibility and reduce the possibility of a device failure at thejunction it bridges. Although shown only as extending along a distalportion of the tube 1723, the score(s) and/or cut(s) may extend over thefull length and/or different portions of the connector tube. FIG. 19Ashows the catheter 1700 before assembly of the proximal with the distalportion. FIG. 19B shows the assembled catheter 1700. The score 1729 isdisposed in this embodiment to traverse a portion of the catheter 1700that may need to flex at the junction of the proximal portion with thedistal dual-lumen portion 1720. As in the embodiments described withreference to FIGS. 16A-18C, this embodiment will provide for efficientflow of inflation fluid.

Another embodiment of a balloon catheter 1900 is shown in FIGS. 20A-20B.FIG. 20A shows, the distal end region of a proximal cable tube 1906covered with jacketing material 1908 (such as, for example,heat-shrinkable PEBAX). The view of FIG. 20A is a longitudinal viewshowing the jacket 1908 in longitudinal section, while FIG. 20B showsthe jacket and the distal dual-lumen catheter portion 1920 in sectionview (with certain internal elements described shown in dashed lines).It preferably is sized such that its inflation lumen 1910 will providefor a flow-rate closely similar to the flow-rate provided byflow-rate-optimized half-round lumen 1922 of the distal lumen portion1920 (particularly when a typical proximal length of the cable tube 1906is taken into account). Rather than a short thin-walled connector tubethat reduces—albeit only slightly—the inner diameter of the proximal anddistal inflation lumens, a ground-down/reduced diameter distal cabletube portion 1927 is provided. Specifically, an outer diameter of alengthwise portion at the distal end of the cable tube 1906 may bereduced by grinding, or some other appropriate mechanical, chemical,electrical, or other means. Whether the alloy tube provided is a cabletube or hypotube, the reduced-diameter portion 1927 may be scored and/orcut in the manner described with reference to FIGS. 19A-19B, such thatit includes at least one cut, score, or combination thereof. The reduceddiameter portion used for connecting the catheter portions whilemaintaining a preferred inner diameter (e.g., cannula 1723, reduceddiameter tube portion 1927) collectively may be referred to as“connecting tube elements.”

As shown in FIGS. 20A-20B, the reduced diameter distal cable tubeportion 1927 preferably is configured/dimensioned for insertion into aproximal portion of the inflation lumen 1922 of the distal dual-lumentube 1920 in a manner providing for efficient flow of inflation fluidtherethrough. Specifically, when the catheter 1900 is assembled as shownin FIG. 20B, a patent path of fluid communication will be providedbetween the cable tube inflation lumen 1910 and the distal memberinflation lumen 1922. The cable tube 1906 has a larger outer diameterand inner diameter in proportion to the distal member inflation lumen1922 when compared—for example—with the embodiments shown in FIGS.14-15. As such, in this embodiment, the inner diameters of the cabletube 1906 and the distal inflation lumen 1922 are more similar andprovide for more rapid flow during inflation and/or deflation of aballoon.

The distal dual-lumen portion 1920 is shown with a wire guide lumen1924. A distal portion of the reduced diameter distal cable tube portion1927 may be roughened or otherwise treated to increase its surface areaand/or frictional profile to improve its bonding with the jacketingmaterial 1908. The distal dual-lumen member 1920 may be constructed ofheat-shrink PEBAX, nylon/PEBAX blend, another suitable material, and/orsome combination thereof that may be bonded (e.g., thermally byheat-shrink, with adhesive, or by some other connecting means) with thejacketing material 1908. The reduced diameter distal cable tube portion1927 and the cable tube 1906 may be provided without any externaljacketing material in some embodiments, and/or a lining may be providedon the inner diameter surface of its inflation lumen 1910.

When assembling the complete catheter 1900 by inserting the distal endof the jacketed proximal portion into the upper/inflation lumen 1922 ofthe dual-lumen member 1920, it may be desirable to provide a mandrelthrough the proximal and distal inflation lumens 1910, 1922 so that amethod step of fixedly attaching those elements (e.g., by thermoset,melt-fusing, sonic welding, applying adhesive, and/or any other methodappropriate for the materials) will not occlude those lumens. A mandrelmay also be provided through the wire guide lumen 1924 during assembly.As shown in FIG. 19, the jacketing material 1908 may extend beyond thedistal end of the connector tube 1923. This may help to secure thecomponents together and provide a smooth transition between the joinedinflation lumens 1910, 1922.

One example of construction is described here with reference to FIGS.17A-18C. A cable tube 1706 is provided having an inner diameter of about0.026 inches (about 0.66 mm) and an outer diameter of about 0.041 inches(about 1.04 mm). A cannula 1723 about 6 to about 10 mm in length isprovided and fused to the inner diameter and/or distal end of the cabletube lumen 1710. The cannula may be spiral-cut as is described withreference to FIGS. 19A-19B. The fusing may be done using, for example,laser welding, soldering, or adhesive. The surfaces of the exposedportion of the cannula 1723, as well as a distal lengthwise portion ofthe distal and proximal ends of the cable tube 1706 are roughened. Next,a PEBAX heat-shrink jacketing is applied and head-shrunk over the entirelength of the tube 1706 and cannula 1723, with about 3-4 mm extendingbeyond the distal cannula end in tube-like fashion with an innerdiameter provided of about 0.020 inches (about 0.5 mm) to about 0.026inches (about 0.66 mm) for the PEBAX sleeve. Although not shown, theportion of the PEBAX jacketing 1708 overlying the distal cable tube body1706 may be trimmed to be flush with the distal cable tube end, leavingthe cannula 1723 jacketed.

Next, a portion of its inflation lumen 1722 will be expanded byinsertion of a mandrel (not shown; may be heated), expanding a proximalportion of its inflation lumen from about 0.021 inches (about 0.53 mm)to about 0.40 inches (about 1 mm) for a length of about 4 to about 5 mm.In this manner, a larger inner diameter “entry portion” of the distalinflation lumen 1722 will be provided to receive the cannula 1723 in amanner that provides a generally circular/cylindrical cavity withoutsignificantly reducing the overall inner diameter that will be availablefor fluid flow in a final assembled catheter 1700, a method that may beused with the different embodiments described herein. As such, the lumen1722 includes an expanded inner diameter that is greater than a moredistal inflation lumen portion and configured for receiving a distalmultifilar tube end, a cannula, a jacketing material, or any combinationthereof. Then, the jacketed cannula 1723 will be slid into the expandedportion of the distal inflation lumen 1722 (e.g., such that the distalend of the cable tube 1706 extends into the distal lumen 1722 by about 2to about 5 mm). Mandrels (not shown) will be inserted through theinflation and wire guide lumens 1722, 1724, then the two portions willbe fused together by heat-bonding, after which the material layers willbe tapered to provide a smooth inner lumen as shown in FIG. 17B and anearly constant outer diameter between the proximal and distal portionsof the finished catheter 1700, although the outer diameter of the distalportion may generally be very slightly greater. FIG. 17B shows (inbroken line) some differentiation of material layers, but where thedistal body 1720 is fused with the jacketing 1708, the materials may befused into essentially a single material. A balloon 1750 will be fusedto the distal end of the dual-lumen portion 1720, such that theinflation lumen 1722 provides a patent path of fluid communicationtherewith, and a proximal hub 1702 will also be assembled to the device1700. In preparation for use of the catheter 1700 as a medical device,the assembly may further include folding down and sterilizing theballoon.

Those of skill in the art will appreciate that other embodiments andvariants of the structures and methods described above may be practicedwithin the scope of the present invention, and that the drawings ofdifferent embodiments are not necessarily to scale (including somefigures specifically noted as not being to scale). It is thereforeintended that the foregoing detailed description be regarded asillustrative rather than limiting, and that it be understood that it isthe following claims, including all equivalents, that are intended todefine the spirit and scope of this invention.

I claim:
 1. A medical balloon catheter, comprising: an elongatenon-interlaced swaged stainless steel multifilar tube, said tubecomprising a proximal multifilar tube end, a distal multifilar tube endfrom which extends a connecting tube element having a smaller outerdiameter than the distal multifilar tube end; an outer diameter of about20-100 mil of the multifilar tube exclusive of the connecting tubeelement, and an inner diameter of about 20-80 mil, where the innerdiameter is less than the outer diameter; a polymer barrier coatingthermoformed around the multifilar tube and the connecting tube element,the polymer barrier comprising a polyether block amide material, andwherein a fluid-patent longitudinal multifilar tube lumen portionextends from the proximal multifilar tube end to a distal end of theconnecting tube element; a dual-lumen polymer tube comprising a proximalpolymer tube end configured to receive the connecting tube element andattached directly to a roughened surface adjacent the distal multifilartube end, a distal polymer tube end, a first lumen configured as afluid-patent polymer tube inflation lumen that extends distally from,and is in patent fluid communication with, the multifilar tube lumen,and a second lumen configured as a wire guide lumen extending parallelto the first lumen with a wire guide aperture immediately adjacent theproximal polymer tube end; an inflatable balloon directly attached tothe distal polymer tube end such that a lumen of the balloon is inpatent fluid communication with the first lumen; where the multifilartube lumen and the first lumen together comprise a substantially patentpath of fluid communication between the multifilar tube end and theballoon lumen; and where the second lumen forms a fluid-patent path ofmechanical communication for a wire guide, which extends from a wireguide aperture near the proximal polymer tube end through the balloonlumen to a distal end of the balloon.
 2. The catheter of claim 1, wherethe polymer barrier coating extends distally beyond the distalmultifilar tube end and the connecting tube element.
 3. The catheter ofclaim 1, where the wire guide lumen portion extending through theballoon lumen comprises at least two radio-opaque marker bandspositioned to indicate an expandable region of the balloon.
 4. Thecatheter of claim 1, where the distal multifilar tube end extends into aproximal portion of the first lumen.
 5. The catheter of claim 1, wherethe direct attachment of the polymer tube to the polymer barrier coatingcomprises a heat-set attachment substantially fusing the two together.6. A method of making a catheter, the method comprising the steps of:providing an elongate non-interlaced swaged stainless steel multifilartube, said tube comprising a longitudinal lumen disposed therethrough, aproximal multifilar tube end, and a distal multifilar tube end; swagingat least one of an outside-facing surface and an inside-facing surfaceof the tube; roughening an outside-facing surface of the distalmultifilar tube end; assembling a polymer barrier coating to anoutside-facing surface of the tube; attaching a proximal end of apolymer tube directly to the polymer barrier coating adjacent the distalmultifilar tube end, where the polymer tube includes a first,fluid-patent, longitudinal lumen in attaching contact with the polymerbarrier and a second longitudinal lumen configured for passage of a wireguide; and attaching an inflatable balloon to the polymer tube such thatan inflation lumen of the balloon is in patent fluid communication withthe first longitudinal lumen of the polymer tube and the secondlongitudinal lumen provides a patent path of mechanical communicationthrough the balloon lumen to a distal end of the balloon.
 7. A method ofmaking a catheter, the method comprising the steps of: providing analloy tube configured for use as a medical catheter, the alloy tubeincluding a proximal alloy tube end, a distal alloy tube end, and analloy tube lumen extending therebetween; providing a connecting tubeelement continuous with and extending distally beyond the distal alloytube end; providing a heat-shrink coating over an external surface ofthe alloy tube and connecting tube element, wherein a portion theheat-shrink coating extends distally beyond the connecting tube elementin tube-like fashion continuing the alloy tube lumen; providing adual-lumen polymer shaft having a first lumen and a second lumen, wherethe second lumen is longer than the first lumen; expanding a proximallength of the first lumen from a first inner cross-sectional area to asecond inner cross-sectional area that is greater than the firstcross-sectional area and that is configured to receive the connectingtube element; inserting the connecting tube element into the expandedfirst lumen portion; and fusing the coated alloy tube to the dual-lumenpolymer shaft.
 8. The method of claim 7, wherein a cross-sectional areaof a lumen inner diameter of the alloy tube is configured to provideabout the same flow rate as the first cross-sectional area of the firstlumen.
 9. The method of claim 7, wherein the connecting tube elementcomprises a cannula fused to the alloy tube.
 10. The method of claim 7,wherein the connecting tube element comprises a distal portion of thealloy tube having a reduced outer diameter.
 11. The method of claim 7,where the connecting tube element comprises at least one cut, score, orcombination thereof that is configured to enhance its flexibility. 12.The method of claim 7, where the first lumen of the dual-lumen shaftincludes a flow-optimized half-round cross-sectional geometry.
 13. Themethod of claim 7, further comprising a step of assembling a balloon toa distal portion of the dual-lumen shaft such that a balloon lumen is inpatent fluid communication with the first lumen, the second lumenextends through the balloon lumen without fluid communication therewith,and a body of the balloon is fused to the dual-lumen shaft.
 14. Themethod of claim 13, further comprising a step of folding down andsterilizing the balloon.
 15. The method of claim 7, further comprising astep of roughening an external surface of the alloy tube, the connectingtube element, or both in a manner configured to enhance attachment withthe heat-shrink coating.